Dear all,
A while ago a friend of mine told me about a new book called “Selling
Sickness” that reveals how normal personality traits and common medical
symptoms are being portrayed as frightening conditions. For instance;
· shyness is “Social Anxiety Disorder”
· boisterously active children now have ADHD
· PMS is now a psychiatric illness called PMDD
He told me that a critique of this book is available on the web at;
http://www.allen-unwin.com.au/exports/product.asp?ISBN=1741145791
I have noticed a similar phenomenon in relation to my ageing mother. A few
years ago she broke her hip and (as she was in her eighties and suffering
from severe osteoporosis) she became bed-ridden. Naturally after a very
active life that had (until then) included many outdoor activities (such as
gardening) she became somewhat despondent. She was taken aback when they
offered her medication for depression. Her response was; in my condition
what sane person wouldn’t be despondent?
A friend of mine happens to be a professor of community medicine who has a
strong interest in geriatrics – and in particular the treatment of
depression and senility in the elderly. Naturally I mentioned this to her.
She told me that basically there are two types of depression; “reactive
depression” (which is a rational despondency to saddening events or
circumstances) and endogenous depression (irrational depression that is not
related to external causes). She told me that the drugs are designed to
combat the endogenous depression or the symptoms of depression and that
many doctors did not bother to make a distinction when treating elderly
people as the causes (bereavement et cetera) are usually beyond control.
However, she did make the point that for rational despondency (“reactive
depression”) it is better in the first instance to find the social or
medical causes and treat those before treating the patient with drugs for
depression. She remarked that they are often related to work or
relationships (or workplace relationships!) and lifestyle factors. There
is, of course, another side to this coin; by some strange coincidence a co-
worker mentioned that Ian Dury (the English pop star) wrote a book
called “Reasons to Live” while he was dying of cancer where he said that
work was his best therapy because it diverted his mind from contemplating
his mortality.
Given the huge focus on overuse injuries, chronic pain and workplace
bullying I am surprised that there is not more discussion in forums like of
the role of work and the workplace as a cause of depression. I have heard
that even colour schemes and décor can affect mental conditions – the white
walls of cells and cheap bed-sitters sometimes get mentioned in relation to
suicides for instance. (I don’t know that ergonomists ever deal with such
extreme outcomes but I have often wondered whether bare walls cause
any “sensory deprivation” effects on either moods or performance; my
workstation is heavily decorated, I might add– I'm not taking any chances! )
When I first trained in ergonomics someone gave a presentation on this
model of ergonomics where the outer layers were the social dimension of
work, private life and public health. This “onion skin view” of ergonomics
placed a lot of stress on emotional states and social relationships in the
workplace in addition to the more traditional physical design aspects. Owen
Evans very kindly supplied me with a reference for the “Onion-skin” model
of ergonomics. It is in “Evaluation of Human Work” (Wilson and Corlett,
1995) as Figure 1.2 on page 10 of that textbook; it is based on an earlier
publication (Grey, Norris and Wilson, 1987). It shows the following layers
(proceeding from the inside to the outside);
· People
· Tasks
· Equipment and machines
· Personal workspace
· Wider workspace
· Physical environment
· Work organization and job design.
Plus the factors that impinge on the outer layer;
· Technical
· Social
· Legal
· Financial
It also contains a vector diagram (figure 1.3 on page 11) that shows the
inter-relationships between the following factors;
· The well-being of the employees,
· The well-being of the organization,
· Health, safety, comfort, satisfaction
· Productivity and quality
It is the inclusion of the “Social” factor and the “well-being of the
employees” in these models that interests me. I have been wondering whether
codes concerning the inner layers of the onion should contain motherhood
statements about these factors given the increasing awareness of the need
for stress management for risk control. It might also be possible to
increase motivation of employers by referring to both well-being and
productivity.
I had been hoping that the outer layers might make mention of the
usefulness of preventive medicine life-style factors (nutrition, physical
exercise, mental activity, habits, social activity, mental health et
cetera) for well-being given the growing popularity of “corporate health”
programs. However, if they are included (possibly they are part of “well-
being”) the mention is not very explicit.
I had been looking for this aspect of our professional work because I have
noticed a boom in the areas of “corporate health”, and training in
wellbeing and wellness. They often cover (or attempt to cover) virtually
all lifestyle factors - exercise, diet, leisure activities, mental
stimulation and so on. Are ergonomists getting involved in these areas?
Does anyone else feel that it might be useful (not to mention entertaining)
to discuss lifestyle issues as well as the more run-of-the-mill stuff? I
cannot help thinking that a broader scope would attract a wider audience
and perhaps (only perhaps!) a little more on-line debate.
From what I am hearing the creation of a “virtual community” might take a
lot of time and money. However, I don’t know how anyone else feels, but I
would like to receive the occasional “news bulletin” about the latest
research papers being published in journals and conferences around the
world. Surely publishers have people on their staff who could take the time
to do this (and indirectly provide their employers with a bit of free
advertising!).
Regards,
David McFarlane
Ergonomist,
WorkCover Authority of New South Wales
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